Immigrant & Refugee Health: How We Provide Health Care to New Americans

Immigrants and refugees have been in the news a lot lately due to our current presidential administration’s policies. Since 1989, more than 6,000 people have come to Vermont through a federal refugee resettlement program.

Listen to an interview with Andrea Green, MD, director of the Pediatric New American Clinic at the University of Vermont Children’s Hospital. She explains the work of the clinic and a new project at Burlington High School designed to send a welcoming message to people of ethnic and religious backgrounds. A transcript of the interview is available below.

UVM Medical Center: Today, we’re going to hear from someone with an interesting perspective on recent changes in refugee and immigrant policy enacted by the Trump administration. Dr. Andrea Green is director of the Pediatric New American Clinic at the University of Vermont Children’s Hospital. Through her contact with parents of her patients, she knows firsthand how both temporary and indefinite restrictions on entry into the US by people from certain countries or with refugee status are being perceived by Vermonters who came here from areas of conflict, including some from the majority Muslim nations in question.

Since 1989, more than 6,000 people have come to Vermont through a federal refugee resettlement program. Dr. Green, who’s also an associate professor at the Larner College of Medicine, is going to tell us all about the work of the clinic and about a project at Burlington High School designed to send a welcoming message to people of ethnic and religious backgrounds. Thanks for coming today.

Andrea Green: Thank you very much for having me.

UVM Medical Center: Let me have you start with telling folks all about the clinic.

Andrea Green: The Pediatric New American Clinic is embedded within the Primary Care Clinic at the University of Vermont Children’s Hospital. When refugees are accepted to the Chittenden County area, they come to our clinic and we do a public health exam to make sure that they’re healthy and then we continue on as their primary care providers, but what we have is specialty knowledge in certain things that they may have experienced overseas, including emotional trauma, and we have resources that we have available to us to help support kids who have some of these unique experiences. In addition, we do a lot of supporting the family unit and having a lot of relationships with community organizations to help support their entry into the US.

UVM Medical Center: It might help people to understand that if you are a refugee coming through the resettlement program, you have been through an awful lot and come from some very bad circumstances.

Andrea Green: It really varies a lot. Some of the Bhutanese families we’re seeing, those children are actually born in the refugee camps, and these refugee camps are like cities. They really develop and become very large, but we have to remember that even though they’re sanctuaries away from maybe a war, these are still not safe places. Families experience issues around not having enough food and issues of violence that can happen within that camp. The families we have coming from places like Iraq, those are families that often have fled to Syria to seek safe haven from the war in Iraq. Those are children who may have seen their schools be bombed, their neighbors be bombed, seen family members dragged out and disappear.

We screen people on arrival to see how they’re adjusting and we actually screen parents, as well. We do a lot of actually trying to support parents because what we know is that healthy parents create healthy kids. Parents’ mental health, and a lot of these parents have really suffered, is really important. What we find is that parents are often willing to seek mental health services to benefit their children. That’s why they’ve come. It’s always about their children. With children, we put in place a lot of things to help them adjust. We have good relationships with schools, and the schools are doing great work to try and help children adjust. We give them all a soccer ball to give them a way to be able to go out and play with other kids, even if they don’t speak the same language, to be able to have fun. We try to build their resilience and acknowledge the resilience that people already have, and then we do have relationships with our own embedded psychologists, with connecting cultures. It provides wonderful work through the UVM Psychology Department and with other mental health services around the area.

UVM Medical Center: What would you say are the most difficult adjustments folks have to make, particularly in terms of medical care, because they’re coming from cultures that may have different definitions of what’s healthy, where they may be unfamiliar with Western medicine?

Andrea Green: I think it’s true. Initially, we often are focused on infectious disease type things that we want to help with. The emotional health piece, I tend to use that word rather than mental health, we talk about emotional wellness. We try to understand that when people are maybe saying they have headaches or stomach pain or back pain that that may well be related to the stress that they’ve experienced. Instead of using words like depression or anxiety, we’ll try to use words like stress or heaviness or other things that might be able to be translated or understood in other cultures. We’ll do a lot of reading about different terms that other cultures might use.

Then we also will talk about traditional healers and acknowledge that they might be people that will be helpful or that prayer might be helpful, people’s spiritual life. We’ll speak to activities that you can be involved in, connecting with community, and how welcomed people feel by the general Vermont community in addition. All of those pieces of making sure that people feel welcome, feel safe, feel integrated, and then sometimes we just have to talk about how our way of life is different. People here feel that we’re really busy and that often our way of life is a lonely way of life. For people who’ve had time for family, which we know is really important, being able to eat meals together, having time together as a family, is really important, that strength which they’ve had prior to arriving we erode through having to have people work really, really hard in order to pay the high rents that are in Burlington. Then they’re not having time with their children and their children spend time with the television instead.

We have open conversations about those things. We really try to acknowledge the good ways that people have brought with them and the ways that they can allow us to reflect on how we operate as a society that may not be healthy.

UVM Medical Center: You’ve learned from them.

Andrea Green: Absolutely. We learn a lot from them. We just have conversations. I think what’s great about being this embedded clinic is that we tend to know these communities and they tend to know us, so we create a good relationship where over time we can be trusted and we can talk about some of the things that are hard to talk about, but we’re often looking to innovative ways to make things better that are outside the clinic.

UVM Medical Center: Like what?

Andrea Green: I remember the Bhutanese when they first came and we talk about what would be the most helpful for the health of your community, they would talk about how they needed a temple because they needed somewhere for the older people in their community to gather and to have purpose and that that would really trickle all the way down and make their whole community healthier. That would be an example of a way that we wouldn’t necessarily think of, the health being related to having a spiritual temple or a place of gathering. That’s absolutely right. We know that those social connections are really important for feeling healthy, but we don’t have a way in our system that we send healthcare dollars to create a community gathering space.

UVM Medical Center: This is happening more, this whole move toward population health. There is acknowledgement that medical care is really only a small part of somebody’s health status. It’s healthy food and housing and being in a safe neighborhood, all of that. It seems like you’re a little bit ahead in acknowledging that or being aware of it and trying to meet those needs.

Andrea Green: I would say the immigrant community’s ahead on that. I think they’ve recognized that they want still to be able to have those foods that they like. In coming here, what they’ve brought with them in enterprise is new markets that provide some of these really interesting vegetables. Some of them, I have no idea what they are when I go into market. They also love the garden programs, and they’re doing a lot with growing their own foods and really have in their natural diet a desire to eat healthy that they bring with them. That’s been a great thing. They’re working at the farmer’s markets and they’re introducing some of their new foods to us, which is exciting.

UVM Medical Center: I want to pivot now and talk about the impact of this new policy that’s come out of Washington and get a sense from you of how this has trickled down to the folks that you deal with on a daily basis.

Andrea Green: Even during the election, people would tell me that they did have a lot of fear. They didn’t have anywhere to go back to. They’d come here because they had no home. They couldn’t go back to the country they’re originally from. They were here and they thought they would be here forever. They were getting citizenship. They were becoming active members of this community, and now they weren’t quite sure what this meant. They were starting to notice that Vermont, which had been a community that was very welcoming, was sometimes feeling a little bit threatening. They’d describe wearing their hijab and maybe sitting at an intersection and feeling like another car was gunning to get ahead of them or looking at them. Another person experienced having rocks thrown at them. They were really feeling that because they dressed differently, people were able to single them out, and they were experiencing people harassing them. I heard from people that they stopped wearing their hijab and they just wore a ski hat, that they were afraid to go outside.

Once the election was finished and the new administration came in, people’s anxiety increased. When the travel ban came, it increased even further. A lot of people have members of their family still to come to this country, and they were really insecure about whether or not that could now happen, whether they’d be able to be together. Some people had family members who had gained citizenship that were now back visiting their home country. Some people in our Sudanese community, for example, have worked to help build schools back in their home country or healthcare facilities in their home country, so they were back seeing family, working on those projects that-

UVM Medical Center: We should say, I’m sorry to interrupt, but Sudan and Somalia, I think, are two of the seven countries.

Andrea Green: Sudan, Somalia, and Iraq we have people from. Those are all countries that were on that banned list. Other people would say after the election, “Well, this is what it is, and we just are going to ride it through and see what it is.” I did get different people feeling different things. I think most definitely the highest anxiety was with people who are from the banned countries and people whose religion was Islam. Right after the election, people did not send their children to school. I know that the schools around here did a great job of reaching out to families, to letting them know that they would be secure. Our mayors reached out and said, “You’re welcome here.” Our Senators, our congressmen, our Governor, have all reached out to try and make it clear that the people we’ve welcomed into our community are still welcome here, but people feel unsure. People feel scared and, in general, that means that they just don’t venture out. They don’t go anywhere. They stay in their homes.

UVM Medical Center: In addition to all those folks you mentioned trying to send a message of welcome, you have Burlington High School students who did that. Tell me about that project and your connection to it.

Andrea Green: This is great. One of the things that was mulling through my head right after the election, we had numerous different meetings that were done to bring together people who work with refugee and immigrant community. In our office, we have posted safe symbols for the LGBT community and I thought to myself, “Wouldn’t it be nice to have something visible that people could see as they walked around that said that the refugee and immigrant community was equally welcome?” I reached out to the superintendents of Burlington High School and Winooski High school to say, “I’d really like to work on this project to kind of create a safe symbol with some of the students, and would anybody be interested?” Both schools were.

It just worked out that Burlington High School International Club and I were able to meet first, so these students started this project of trying to create a symbol and it was this wonderful thing to see in that they all had different ideas and all these children were from different places. Over time, it migrated to an idea of open hands that would symbolize welcoming and protection and then a bird because birds migrate and everyone came from somewhere where there were doves, and doves were a symbol of peace, so they decided to make it a dove sitting in this nest of welcoming hands. Susan Blethen, who’s their teacher, and I worked with them on this. Tyler Litwin, who is one of our neonatologist’s husband, helped to put it into a graphic symbol, and then people took it and they shared it widely.

The symbol is posted in different schools in our community. The students at Burlington High School took it down and walked around different stores on Church Street and asked them to post the symbol. We sent it out through our Refugee and Immigrant List Serves, and so it’s being posted and used across the country in different communities, like Philadelphia, Charlottesville, Virginia, Washington, DC, and it’s been incredibly empowering to see these students create something and then have it be lifted up around them. It’s made them feel really welcomed.

Furthermore, the American Academy of Pediatrics heard about it and have invited one of the students to come to present it at their forum. The Winooski Students Peace Jam Club is taking it to a Peace Jam Conference where they’re going to get to meet a Nobel Prize winner from Africa and they’re going to share it with her. It’s just allowed these students to really have a voice, to feel welcome, to feel included, and to go home and be able to share that with their parents and help their parents to see that we do have the ability to create an inclusive community and that through gathering together, through raising our voice, we can show a different side. We can be inclusive and we can make that note.

UVM Medical Center: That’s really great and a positive note to end on. I want to thank my guest for being with me today. Dr. Andrea Green, who is director of the Pediatric New American Clinic at the University of Vermont Children’s Hospital and associate professor of pediatrics at the Larner College of Medicine. Thanks so much and good luck with your work.

The University of Vermont Medical Center serves all of Vermont and the northern New York region. Located in Burlington, The UVM Medical Center is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont